Will Comparing Drugs Destroy America?

By Jeffrey Young

Some conservatives might be shouting from the rooftops that federal funding for comparative effectiveness research on drugs, medical devices, surgeries, etc., will lead our nation inexorably toward government rationing of health care. One pharmaceutical executive I recently spoke with says he just doesn't see it.

The economic stimulus bill signed into law by President Obama earlier this year provides $1.1 billion for scientific research on the comparative effectiveness of medical treatments. The idea behind it is to develop a better body of knowledge about whether, say, one cholesterol medicine works better than another one in a certain type of patient.

To critics, though, it conjures up a nightmare scenario in which Uncle Sam uses the results of this research to decree that we can only take the drug that "wins" in the study and/or is less expensive. Countries with nationalized health care systems, such as the U.K., have government agencies that make these kinds of decisions (though it's not nearly as simple as that).

AstraZeneca CEO David Brennan was in Washington last Friday and met with reporters for an hour-long discussion that touched on a lot of issues but, given that I'd written about this comparative effectiveness controversy before, I asked him what he thought about those dire pronouncements of what it could mean for our health care system.

Here's what Brennan said:

It's not obvious to me yet that that's a particular kind of an issue. I think it is a concern that it should be looked at. I mean, I think as a principle, certainly I would say that everything that can be done to encourage patient-physician interaction should be part of how this is looked at. ... I don't know exactly what the bill does that causes people to say that, other than it's providing funding to a bunch of places to come up with reports, to consider running some trials, et cetera.

Now, the pharmaceutical industry and other medical industries lobbied pretty hard to make sure that the word "cost" didn't appear anywhere near the words "comparative effectiveness" in the stimulus bill. Their campaign contributed, at least indirectly, to how ugly the discussion about this fairly wonky subject became.

Nevertheless, Brennan could have gone an entirely different direction with his answers but instead focused on the potential benefits. "It is an opportunity to bring into the clinical-decision process more evidence," he said. "I think comparative effectiveness has an opportunity to let us treat people better."

Brennan did raise concerns about using the research to make broad "population-based" decisions about coverage rather than simply providing the information to doctors and patients. "If comparative effectiveness research becomes code for cost comparison, then we've missed an opportunity to really demonstrate, from an evidence perspective, better ways to treat individual patients that actually create value in the system," he said. He also argued against the Food and Drug Administration including cost consideration in new drug approvals but said, in the context of national health reform, "It's very difficult for me to envision that we're going to have this discussion and cost isn't going to be part of it."

UPDATE: Meanwhile, it looks like the acting director of the National Institutes of Health just gave critics of comparative effectiveness research more cause for concern.

Jeffrey Young is a staff writer at The Hill.

This article available online at:

http://www.theatlantic.com/business/archive/2009/03/will-comparing-drugs-destroy-america/7051/